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article imageLung biopsies of vaping patients show injury from toxic chemicals

By Karen Graham     Oct 3, 2019 in Health
Doctors researching the cause of a sudden respiratory illness that’s killed at least 16 people in the U.S. since July say a mix of “toxic chemical fumes,” not oils as previously expected, may be what’s making patients sick.
In the wake of the perplexing vaping illness that has sickened over 805 people and caused 16 deaths in the United States, pathologists at the Mayo Clinic reviewed lung biopsies from 17 patients suspected of having the unusual lung illness.
Of the 17 lung biopsies examined, 13 were from men between the ages of 19 and 67 - with the median age being 35 years old. All the patients had a history of vaping marijuana or cannabis oils. The pathologists found no evidence of lipoid pneumonia, a rare diagnosis typically associated with people accidentally inhaling oils into their lungs.
The pathologists released their findings in a letter published in the New England Journal of Medicine on October 2, 2019.
Macrophages  are a type of white blood cell in the immune system that engulfs and digests cellular d...
Macrophages are a type of white blood cell in the immune system that engulfs and digests cellular debris, foreign substances, microbes, cancer cells, and anything else that does not belong. This is a macrophage preparing to engulf a bacterium.
Obli at English Wikipedia.
Their findings contradict a study of five patients in North Carolina, published on September 6 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The article describes five cases of vaping-related illness in North Carolina, in which patients were diagnosed with acute exogenous lipoid pneumonia. The study also noted that "the CDC said it believes “a chemical exposure is likely” causing illnesses and is looking into multiple possibilities including reports linking the illnesses to vitamin E acetate.
In those five cases, doctors examined cells from patients with severe lung injury and found immune system cells called macrophages filled with oil. They diagnosed all five with lipoid pneumonia.
Lipoid pneumonia (chemical pneumonitis) can result from the  inhalation or aspiration of hydrocarbon...
Lipoid pneumonia (chemical pneumonitis) can result from the inhalation or aspiration of hydrocarbons of different types or other toxic chemicals.
Yale Rosen
However, the pathologists in the Mayo Clinic study - which was the first foirmal study to examine tissue samples of patients who had become ill after vaping - said none of the cases they examined showed any evidence of lipoid pneumonia, reports CNBC News.
“It seems to be some kind of direct chemical injury, similar to what one might see with exposures to toxic chemical fumes, poisonous gases and toxic agents,” said Dr. Brandon Larsen, a surgical pathologist at Mayo Clinic Arizona and a lead author of the study.
“Based on what we have seen in our study, we suspect that most cases involve chemical contaminants, toxic byproducts or other noxious agents within vape liquids.”
We still don't know what is going on
Based on the latest information, 87 percent of the 86 people in Illinois and Wisconsin who got sick from vaping admitted to having used THC, however, 71 percent also reported using nicotine-containing products.
What this means is simple - health officials just don't havce any definitive answers, but it is not for a lack of trying. Dr. Laura Crotty Alexander, a pulmonlogist who studies vaping at University of California San Diego, said the Mayo findings are in line with other studies suggesting the injuries are related to a toxin entering the lungs.
A vape shop or lounge.
A vape shop or lounge.
Lindsay Fox from Newport beach, USA (CC BY 2.0)
“This is just putting further emphasis on the fact that lipoid pneumonia is not the pathologic pattern being seen in this epidemic,” she said in an email to Reuters.
Bottom line? Health officials are urging consumers not to use e-cigarettes or other vaping products. The CDC is going one step further and asking consumers to not buy black market vapes on the street and to please, not add any substances to products that are not intended by the manufacturer.
More about vaping illnesses, Toxic chemicals, lung injury, Lung biopsy, lipoid pneumonia
 
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